Health Reform
and the Affordable Care Act
Challenges and Opportunities Ahead for
Local Health Departments
The National Connection for Local Public Health
THE BIG PICTURE
The Patient Protection and Affordable Care Act
(ACA) sets the stage for a comprehensive
national approach to population-based prevention.
•
Health in all policies through a National Prevention
Strategy
•
Recognition of policy and environmental change
approaches to public health
•
Mandatory appropriation (new money)
THE BIG PICTURE
The ACA includes provisions for:
•
Public health workforce development
•
Enhancement of the evidence base for prevention and
public health
•
First dollar coverage of clinical preventive services by all
public and private insurers (for new plans)
ACA Public Health Benefits
Prevention and Public Health Fund
$15 Billion/10 years
$500 million/FY2010, ramping up to $2 billion in FY2015 and
each year thereafter
•Provides for expanded and sustained national investment in
prevention and public health programs authorized by the
Public Health Service Act for prevention, wellness, and public
health activities, including prevention research and health
screenings
The Prevention and Public Health Fund – A
Groundbreaking Approach
• A “mandatory appropriation” (does not require
Congressional action for funds to be available each
year). This was a huge victory for public health.
• Congress and the Administration have concurrent
authority to allocate the Fund. If Congress does not
do so, the Administration will.
The “Reality Check” Has Already Begun
• FY10 - $500 million, of which half went to primary care
workforce development by decision of Administration.
• FY11 - $750 million – to public health and prevention
• FY12 - $1 billion – at the mercy of a new Congress.
• The first Congressional attempt to defund the Fund failed
last year and more attacks are a certainty.
• Few local health departments have received any dollars
from the Fund so far.
Prevention and Public Health Fund – Current Status
FY11 - $750 million
$145 million – Community Transformation Grants
$40 million – Natl Public Health Improvement Initiative
$40 million – Epi/Lab Capacity Grants
$52.2 million – Comprehensive Chronic Disease
$20 million – Public Health Workforce Development
The “Reality Check”
If the Prevention and Public Health Fund survives:
• Annual advocacy for allocations that benefit local health
departments will still be needed.
• The competition for new funds is intense.
• There is insufficient funding for all the new programs
authorized by the ACA. Some promises will be empty.
The Work of Implementation Has Barely Begun
The new law provides a host of essential building
blocks for improving health status through
evidence-based prevention and public health.
Sustained advocacy for funding and for sound
federal and state policies that guide
implementation will be critical.
It will take many years and a healthier economy
before that potential can be realized.
The Big Question
Question:
Answer:
Is Health Reform a
Threat or an
Opportunity for Local
Yes.
Health Departments?
The Rules of the Game Are Changing But the New
Rules are Unknown
Local Health Departments Across the Country Are In
the Same Boat: Threat or Opportunity?
A Conundrum for Health Departments and their Partners
On the one hand, the
Administration is
moving full speed
ahead on
implementation.
On the other hand, the
GOP, with a new
majority in the House
(but not the Senate) is
determined to gut the
law.
So What Do We Do? Two Things At Once.
1. Play offense. Assume the key aspects of the law will
remain in force and work to address the opportunities and
challenges locally.
AND
2. Play defense. Explain the law to your communities and
join NACCHO in advocating vigorously for maintenance
of the Prevention and Public Health Fund and other
aspects essential to improving the nation’s health.
Local Opportunities: New Roles and Functions to
Consider
• Expanded role in Medicaid enrollment and in
outreach and enrollment for state health
insurance exchanges
• Expanded role in case management.
• Maintain and enhance role as health data and
information experts for the community.
New Roles and Functions to Consider
• Collaborate with non-profit hospitals to conduct community
health needs assessments required by IRS.
• Develop new business models to bill or contract for
services.
• Leverage the dollars flowing to FQHC’s by developing a
public entity FQHC.
New Partnerships to Consider
• Convene partnerships for population-based prevention,
including the engagement of new partners in policy
development.
• Pursue relationships with groups forming Accountable
Care Organizations.
• Establish new arrangements with FQHC’s for co-location
of services, referrals, and/or purchase of services.
Some Questions to Ask
When more health department clients have
insurance cards in hand, what will be the impact
on financing and mix of clinical and populationbased services in my community?
Should I plan to transition clinical services to other
providers and focus more resources on
population-based prevention?
Systemic Challenges That Affect LHDs’ Approaches
• Lack of community support for health system
reform.
• Lack of State willingness or capacity to implement
Affordable Care Act.
• Possible influx of new patients to health care
systems with inadequate reimbursement or
resources (particularly PCPs) to care for them.
Local Health Department Challenges
• Viability as a safety net provider.
• Inability to compete as other entities assume
greater roles in prevention and primary care.
• Future funding reductions for public health
services erroneously deemed unnecessary by
policy makers when expanded health insurance
coverage is in place.
Local Challenges
• Realigning resources for altered roles.
• Training the current public health workforce for
altered roles.
• Pursuing new opportunities after years of cuts
have weakened the public health system.
Some Views from Other Local Health Departments
(from open discussion at NACCHO Annual meeting)
• “This is all very scary but also very exciting.”
• Our fear is that we will have to redefine ourselves.
We may have to give up what we are more
comfortable with.”
Some Views from Other Local Health Departments
(from open discussion at NACCHO Annual meeting)
• “We need to be the data and information gurus in
the community….we look at indicators and
outcomes.”
• “We can make real health reform work in the
community. I know that we all can’t just do that
tomorrow, but if we nurture new partnerships and
collaborations, those are the keys to making this
work.”
Some Views from Other Local Health Departments
(from open discussion at NACCHO Annual meeting)
• “You have to get yourself to the table to be part of
the conversation….Pay attention! Make sure you
are there!) (reference to regional discussions
among hospitals, health insurers, community
health centers)
• “We’ve got to stop saying health care reform won’t
work and rather bond together and figure out how
to make it work for our communities.”
• “
NACCHO Resources
A webpage with resources that we are populating as fast as
we can:
http://www.naccho.org/advocacy/healthreform.cfm
Tell us what you think and what you need!
Email: healthreform@naccho.org
Other Resources
White House: http://www.whitehouse.gov/HealthReform
Department of Health and Human Services:
http://www.healthcare.gov/
Kaiser Family Foundation: http://healthreform.kff.org/
Families USA: http://www.familiesusa.org